Should Osteosynthesis Material in Cranio-Maxillofacial Trauma be Removed or Left In Situ? A Complication-associated Consideration

For many years, the vast majority of cranio-maxillofacial fractures require rigid osteosynthesis by the use of titanium plates and screws. Because titanium is biologically inert, most surgeons around the world do not remove osteosynthesis material (OM) routinely as long as it is not symptomatic. However, its continued presence in the body can be associated with side effects like infection with plate exposure, pain, plate palpability over sensitive facial areas, cold intolerance, soft tissue erosion, sinusitis, and nerve and tooth damage. Once those complications are present, removal of titanium hardware is mostly required. Apart from those case-specific indications, there are a few strong indications for elective hardware removal. When considering the present literature still today, there is no consensus among treating surgeons in terms of long-term management of titanium hardware used for the osteosynthesis of craniofacial trauma. Therefore, this chapter discusses and explains the pros versus cons of elective metal OM removal and gives an overview about potential long-term systemic side effects of titanium like corrosion if left in situ for ever.